Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the immune system mistakenly attacks the body’s own healthy tissues and organs. While known for its systemic effects on major organs, the inflammation associated with Lupus frequently extends to the oral cavity. This systemic activity often results in complex dental and soft tissue problems, damaging the mouth’s lining, compromising structures supporting the teeth, and introducing risks through necessary medical treatments.
Direct Effects on Oral Soft Tissues
Lupus frequently causes direct inflammatory symptoms on the mucosal lining of the mouth. The most common manifestation is the appearance of oral ulcers or lesions, affecting approximately 30% to over 50% of people with SLE. These lesions differ from common canker sores because they are often painless, meaning they can go unnoticed by the patient.
When associated with active disease, these ulcers often present a distinctive appearance: a red center surrounded by a white, radiating halo. These characteristic sores frequently develop on the hard palate, the inner cheeks, and the lower lip. Lesions related to discoid lupus, a form of cutaneous lupus, also appear as erythematous patches with white, scaly borders, sometimes resembling lichen planus. Chronic oral lesions, particularly those that persist, warrant careful monitoring due to an increased risk of developing squamous cell carcinoma.
Impact on Teeth and Periodontal Health
The chronic systemic inflammation defining Lupus affects the health of the teeth and their supporting structures. Individuals with Lupus face a significantly higher risk of developing severe periodontitis, the advanced stage of gum disease. This is attributed to shared inflammatory pathways that are overactive in both conditions, leading to continuous tissue destruction.
The generalized inflammatory state makes SLE patients three to four times more likely to develop severe gum disease compared to the general population. This persistent immune dysregulation triggers an overactive response to oral bacteria. This results in the irreversible loss of the periodontal ligament and alveolar bone that anchors the teeth, increasing the risk of tooth mobility and eventual tooth loss.
The compromised oral environment and overall disease activity also contribute to a high prevalence of dental caries, or tooth decay, and an increased number of missing teeth. Active disease is strongly associated with the presence of tooth decay. The chronic tissue degradation and increased susceptibility to infection create conditions where the hard tissues of the teeth are more vulnerable to damage.
How Lupus Medications Influence Oral Health
The medications used to manage Lupus, while necessary, can introduce indirect challenges to oral health. A primary concern is Xerostomia, or chronic dry mouth, a common side effect of many immunosuppressants, corticosteroids, and antimalarial drugs. This reduction in saliva flow is detrimental because saliva acts as the mouth’s natural buffer, neutralizing acids and providing antibacterial protection.
The loss of this protective function drastically increases the risk of tooth decay and opportunistic infections, such as oral candidiasis (thrush). Furthermore, an estimated 20% to 30% of people with Lupus also develop secondary Sjögren’s Syndrome, which directly attacks the salivary glands. This co-occurring condition severely exacerbates Xerostomia, leading to profound oral dryness and magnifying dental risks. Other immunosuppressive therapies can also impair the body’s ability to fight off minor infections and delay the healing of oral tissues following trauma or dental procedures.
Essential Oral Care for Lupus Patients
Oral care for Lupus patients must be tailored to mitigate the specific risks posed by the disease and its treatment. Managing Xerostomia is essential, involving consistent hydration, the use of over-the-counter saliva substitutes, and prescription-strength fluoride products. Since reduced saliva increases the risk of decay, the dentist may recommend high-concentration fluoride toothpaste or rinses to remineralize enamel.
To avoid irritating existing oral ulcers, patients should use a soft-bristled toothbrush and may benefit from toothpaste that does not contain the foaming agent sodium lauryl sulfate (SLS). Avoiding hot, spicy, or acidic foods is also advised, as these can aggravate mouth sores and slow healing. Due to the increased risk of periodontal disease and infection, frequent dental check-ups are necessary, often at shorter intervals than the standard six months. Maintaining open communication between the rheumatologist and the dental team ensures that medical and oral treatments are coordinated.